Mesenchymal Stem Cell therapy for COVID-19-induced ARDS patients. A successful phase1, randomized, control-placebo group, clinical trial

BackgroundAcute respiratory distress syndrome (ARDS) is the devasting complication of the new COVID-19 pandemic, directly correlated with releasing large amounts of inflammatory cytokines. Due to their immunoregulatory features, Mesenchymal Stem Cells (MSCs) provide a promising approach against this disease. In this regard, this study was designed as a single-center, open-label, phase 1 clinical trial with a control group to examine the safety and efficacy of three injections of Umbilical Cord-derived MSCs (UC-MSCs) in mild-moderate COVID-19-induced ARDS patients.MethodsTwenty confirmed COVID-19 patients with mild to moderate ARDS degree (using the WHO guideline for ARDS classification) entered the study and were randomly divided into two groups: control group (standard care) and intervention group (standard care + UC-MSCs). The patients received three intravenous infusions of UC-MSCs (1 × \({10}^{6}\) cells/kg BW per injection) every other day. Respiratory markers, CRP levels and some serum cytokines were assessed four times (days of 0,5,10 and 17) during the 17 days follow-up period.ResultsDuring the study, there were no serious adverse effects after cell transplantations. Besides, significant improvement in SPO2/FIO2 ratio and serum CRP levels was observed. On the other hand, a significant decrease (P<0.05) in serum cytokine levels of IL-6, IFN-g, TNF-α, IL-17 A and a significant increase in serum cytokine levels of TGF-B, IL-1B and IL-10 was observed. Also, no significant changes were observed in CT scan images of patients during the study period.ConclusionOur obtained results demonstrated that multiple intravenous transplantations of allogenic UC-MSCs in non-severe COVID-19-induced ARDS patients are a safe procedure. In addition, this intervention is a hopeful approach to decline cytokine storm and recover respiratory functions. Indeed, more clinical trials with larger sample sizes are required to confirm these results.Trial registrationThis clinical trial was registered with the Iranian Registry of Clinical Trials (ID: IRCT20160809029275N1 at 2020.05.30).